A Manufactured Epidemic

The overdiagnosis of ADHD is " national disaster of dangerous proportions,” says one M.D.

If at any time while reading this article your attention wanders, you may have ADHD. If you pause to check your e-mail sometime during the next three paragraphs, you should consult a doctor. If you fail to read this article all the way to the end, you should get on Adderall, Ritalin, or some other drug to treat your condition as soon as possible.

This isn’t quite the standard for diagnosing attention-deficit hyperactivity disorder, but it’s close. The New York Times ran a long exposé on how the drug industry has stoked the diagnosis and treatment of ADHD. The exposé contained a revelatory quote from Keith Conners, a doctor who has long advocated for the recognition of the disorder.

Conners called the overdiagnosis of ADHD “a national disaster of dangerous proportions,” telling the Times that the rising number of cases “is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.” This isn’t bomb-throwing from an outsider, but a critique from the namesake of the Conners ratings scale widely used to evaluate kids for ADHD.

There is no doubt that ADHD is a legitimate neurological condition that makes kids (and those around them) miserable, that blights their potential, and that can be alleviated by prescription stimulants like Adderall and Ritalin. There also is no doubt that diagnosis and treatment of the disorder has run wildly out of control on the promise of an easy pharmaceutical fix to the natural rambunctiousness of childhood.

The six-year-old boy notoriously suspended from a Colorado elementary school on charges of sexual harassment for the offense of kissing a girl’s hand summarized the matter nicely: “I just have a lot of energy! I mean six-year-olds — they have a lot of energy!” No kidding. Our increasing unwillingness to distinguish between run-of-the-mill childishness — which, by definition, is heedless and frustrating at times — and a condition requiring pharmaceutical treatment is at the root of the ADHD epidemic.

According to the forthcoming book The ADHD Explosion, 19 percent of high-school-aged males have received a diagnosis. The numbers differ from state to state. In North Carolina, an astounding 30 percent of boys over age nine are supposedly suffering from ADHD. Overall, 6 percent of children and adolescents in the United States are on drugs to treat ADHD.

It’s a wonder more kids aren’t diagnosed with it, given the overlap between the description of the disorder and failings to which we are all prone. The New York Times points out that the American Psychiatric Association criteria for ADHD include “often has difficulty waiting his or her turn” and “makes careless mistakes,” hardly rare childhood behaviors. Lowering the bar further, drug companies sponsor online quizzes telling people they may have ADHD if they have trouble with things like “remembering appointments” or “getting things in order.”

The drug companies — for whom ADHD is a $9 billion-a-year business — target mothers with alluring ads suggesting their children will become little angels through the wonders of risk-free stimulants. Their kids will get better grades, spend more quality time with the family, remember to take out the trash, and shower everyone around them with good cheer. Who wouldn’t want their child thus magically transformed? According to the Times report, the Food and Drug Administration has constantly rebuked the companies for going beyond the evidence in selling visions of childhood Valhalla secured through the right drug.

Undertrained primary-care physicians and worried parents default much too often to the diagnosis of ADHD and to the answer of a prescription. The next frontier is adult ADHD, with the promise of a vast new pharmaceutical market made up of people deprived of ADHD diagnoses when they were children. Some of these diagnoses will be warranted and life-changing, but others will be overreach prompted by vague and dubious symptoms, like inattentive op-ed reading.